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HIV testing of infant and birthmother prior to adoption
Jun 11, 2004

My husband and I are considering adopting an infant from Haiti. We have been told that a baby can test negative for HIV but still develop HIV a couple of years later. Is this true? At what point would the test be reliable, and what type of test should be used? Also, we have been told that if we adopt a newborn, we might be able to request HIV testing of the birthmother. Would a negative test result for the mother positively ensure that the infant did not have HIV, and if so, what test should be used for the mother? Thank you.

Response from Dr. Luzuriaga

A baby would only be at risk if his/her mother were HIV positive. If the mother is available for testing and consents, a test for antibodies would be diagnostic. If the mom were found to be HIV positive, she would hopefully be offered antiviral therapy for her health and to prevent transmission of the virus to the baby.

If the mother is not available, the baby should be tested to determine his/her infection status. Since antibodies pass from moms to babies during the last trimester of pregnancy, any baby born at full term to an HIV positive woman will also be antibody positive; thus, a positive antibody test in the baby (any time from birth to about 6 months) would indicate that the baby is at risk for infection. However, only 15-30% of infants born to HIV positive women acquire HIV infection in the absence of therapy. So, more specific testing is necessary in infants; RNA or DNA PCR detect viral nucleic acids in the baby's plasma or white blood cells and are used to determine infection status in infants. Because most babies acquire infection at birth, the RNA or DNA PCR may be negative at birth but positive by 1 months of age. We therefore recommend testing of infants at risk at birth, 1 month, 2 months, and 6 months. If a non-breastfed baby is negative through 6 nonths of age, infection is extremely unlikely.

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